GIAN SUNGA

LEE VARIAS
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FORM 1 Worksheet
FORM 2 Waiver
FORM 3 Post Sentence Investigation Report (PSIR)
FORM 29 Application for Probation
FORM 9 Final Report
FORM 11 Indemnification Payment Plan
FORM 16 My Personal Development Plan (Formerly STP
FORM 25 Pre-Parole/Pre-Executive Clemency Investigation Report
PPA FORM 1
REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF JUSTICE
PAROLE AND PROBATION ADMINISTRATION
CAVITE
TAGAYTAY CITY

Date of Initial Interview: JUNE 11, 2023 Criminal Case No. 2023-1234
Interviewed by: Jerico P. Taaca Inv. Docket No. P.I 20203-1234

WORK SHEET

I. IDENTIFYING DATA

PETITIONER:
SAMSUNG KELLY BAGSIK
(Last Name) (First Name) (Middle)

ALIAS/ES: “Kel
Present Address: GUINHAWA SOUTH, TAGAYTAY CITY, CAVITE
Permanent Address: GUINHAWA SOUTH, TAGAYTAY CITY, CAVITE

II. PETITIONER’S CRIMINAL HISTORY

A. PRESENT OFFENSE

Charged With ADULTERY Date: JUNE 13, 2023

Place of Commission GUINHAWA SOUTH, TAGAYTAY CITY
Date: June 13, 2023_
Convicted of ADULTERY Date: JUNE 20,2023
Sentence two years six months and twenty-one day of Prision Correctional
Judge Hon. Peppa Malkova Court MTC TAGAYTAY CITY
Arresting Officer PMSg Gian Marlo Address TAGAYTAY CITY
Defense Counsel Atty. Ace Alleje Address INDANG, CAVITE
Prosecutor Ramon Pogi Address: TAGAYTAY
CITY Offended Party Clyde Samsung
Address TAGAYTAY CITY
Co-Accused N/A
Aggravating Circumstances Adultery is committed in the conjugal dwelling
Mitigating Circumstances: Adultery is mitigated if the adulterous wife was abandoned
w/o justification by the offended spouse.
Custody Status: ( / ) On Bail ( ) On Detention Period of Detention
( ) ROR – Custodian:
Address:

Extent of Participation: ( / ) Principal ( ) Accomplice ( ) Accessory

Manner of Commission: (Narrative)

1
PPA FORM 1

Motive ( ) Unintentional ( ) Circumstantial ()

s: Imprudence

( ) High Times ( ) Temper ( ) Others

Explain
:

B. PRIOR RECORDS As Alleged by: ( ) Petitioner ( ) Other Source

( / ) No Record
( ) With Derogatory Record

Agency CC No. Offense When Where

Disposition
NBI
RTC
MTC
PNP

Prosecutor

Barangay

CMRD

( ) Has been (/)not been on Probation

Other Derogatory Information

Source/Date Position Particulars

III. PERSONAL AND SOCIAL HISTORY

A. IDENTIFICATION DATA

Sex: Female Civil Status: Married Citizenship: Filipino

Religion: Roman Catholic
DOB: June 12, 1985 Age: 38 yrs POB: TAGAYTAY CITY
Identifying Marks: ( ) Tattoo (/) Mole ( ) Scars
( ) Others Description: _
Physical Handicap:
PPA FORM 1

B. FAMILY BACKGROUND

1. PARENTS

PATERNAL MATERNAL
NA Tatay Samsung Nanay Samsung
ME June 11, 1959
DOB August 28, 1957 63 yrs old
Age
66 yrs old

POB Tagaytay City Indang, Cavite

Address Tagaytay City Indang, Cavite

Citizenship Filipino Filipino

Religion Roman Catholic Roman Catholic

Education College Graduate College Graduate

Occupation Engineer Housewife

Work Tagaytay City Cavite N/A

Address
Tel. No. 09996665587 N/A

Monthly Income 400,000 N/A

Date Deceased
Cause

Civil Status: ( /) Married ( ) Separated ( ) Live-in/Common-Law

Relationship with Parents: ( ) Poor ( ) Fair ( /) Satisfactory

( ) Very Satisfactory

Name of Siblings Degree of Rel. Age Educational Attainment Occupation

N/A

2. SOCIO-ECONOMIC BACKGROUND

Family-Relationship Major Family Problems Family Reputation in the

Comm.

( ) Very Satisfactory ( /) No Apparent Problem (/ ) Very

Satisfactory
PPA FORM 1

( /) Satisfactory ( ) Satisfactory ( ) Satisfactory

( ) Fair ( ) Mental Illness ( ) Fair
( ) Poor ( ) Marital Problem ( ) Poor
( ) One-Parent Family
( ) Sibling Conflict
( ) Others
PPA FORM 1

Family Economic Status Physical Home Conditions Stability of Residence

Comments: (Effects of the above conditions on the petitioner’s Behavior)

CHILDHOOD CIRCUMSTANCES: ( ) Sad ( / ) Happy

Explain:
The petitioner’childhood was explained as happy due to massive spoils of the petitioner`s
father

Civil Status: ( ) Single ( / ) Married ( ) Widow/Widower ( ) Common-Law

( ) Separated,Cause: Relationship

1. SPOUSE: Samsung Clyde Ramos Age: 38

Family/Maiden Name First Name Middle Name

Home Address: Tagaytay City, Cavite

POB: Tagaytay City, Cavite DOB: June 13, 1985
Occupation: Welder Work Address: Tagaytay City, Cavite
Date of Marriage: May 1, 1983 Nature of Ceremony: Church Wedding
If Separated, State Reason/s:

Relationship with Spouse: ( /) Poor ( ) Fair ( ) Satisfactory

( ) Very Satisfactory

2. CHILDREN: No. of Children: n/a

NAME D.O.B. AGE EDUCATIONATTAINMENT

Relationship with Children: ( ) Poor ( ) Fair ( ) Satisfactory

( ) Very Satisfactory
PPA FORM 1

3. RESIDENCE
Past Residence (Last ten [10] years)

Address Inclusive Dates

- Guinhawa South, Tagaytay City 1985-2023

Stability of Residence Type of Residence Physical Home

Conditions ( ) Stable ( / ) House ( ) Very Satisfactory
( /) Occasional Change ( ) Apartment ( /) Satisfactory
( ) Frequent Change ( ) Rented ( ) Fair
( ) No Stability ( ) Owned ( ) Poor
( ) Others
4. ECONOMIC CONDITIONS

Family Economic Status Family Breadwinner No. of Dependents (

) More than Adequate ( ) Petitioner ( ) Children
.
(/ ) Adequate ( /) Spouse ( ) Others
( ) Inadequate ( ) Pet. and Spouse
( ) Below Poverty Level ( ) Others

5. MAJOR FAMILY PROBLEMS IN THE FAMILY

( ) No Apparent Problem ( ) Mental Illness ( ) Sibling Conflict
( ) Economic ( ) Physical Illness ( ) Others
( /) Husband-Wife Conflict ( ) Parent-Child Conflict

COMMENTS: (Effects of the above conditions on the Petitioner’s behavior)

C. PETITIONER’S EDUCATIONAL HISTORY

Educational Where Date attained Highest Level Honor/Award

Level

Elementary Tagaytay City 1989-1995 N/A

Elementary School

Secondary Tagaytay City 1995-2001 N/A

High School

College Tagaytay City College 2001-2005 N/A

( ) Unschooled but literate ( ) Illiterate

Over-all Conduct in School: ( ) Poor ( / ) Fair ( ) Satisfactory

( ) Very
Satisfactory
PPA FORM 1

Explain:

The Petitioner performed in a fair performance academically due to struggling academically.

PPA FORM 1

D. EMPLOYMENT HISTORY

Petitioner’s Previous Occupation/s

Job Held Employer / Address Dates Income

Accountant Tagaytay Bank 2010-2023 145 000php

AAA
Status of Employment/Self Employment
( / ) Regular ( ) Irregular
( ) Specify: _

If unemployed, state means of support:

( ) Pension ( ) Children Support ( ) Others
Specify:

Employable Skills:
( ) Auto Mechanic ( ) Electrician ( ) Hollow Block Maker
( ) Machine Operator ( ) Plumber ( ) House Painter
( ) Driver ( ) Mason ( ) Portrait Artist
( ) Welder ( ) Carpenter ( ) Billboard Artist
( ) Radio Technician ( ) Baker ( / ) Others accountant

Other Sources of Income:

( /) Sari-sari Store ( ) Junk Collector ( ) Cattle Raising

( ) Ambulant Vendor ( ) Piggery ( ) Farming
( ) Balut Vendor ( ) Poultry Raising ( ) Machine Aide
( ) Fish Vendor ( ) Flower Gardening ( ) Metro Aide
( ) “Bote-Garapa” ( ) Vegetable Gardening ( ) Janitor
( )Others:

Physical Health: ( ) Poor ( ) Fair ( /) Satisfactory ( ) Very Satisfactory

Explain:

The petitioner`s physical is satisfactory due to occasional attendance to Zumba programs

nearby and other physical activities. The petitioner is also a very seldom attendee at any
hospitals
PPA FORM 1

Previous Treatment/Hospitalization: ( /) None ( ) Yes, Specify:

Name of Hospital/s:
Date/s Hospitalized:
Use of Alcohol/Drugs: ( ) Yes ( /) No ( ) Occasionally

Explain:

The Petitioner does not intake any alcohol or drugs

E. COMMUNITY BACKGROUND/ENVIRONMENTAL FACTORS:

Neighborhood: ( /) Rural ( ) Slum Area ( ) Non-Slum Area

( ) Urban ( ) Slum Area ( ) Non-Slum Area

Describe: The residence of the Petitioner, Guinhawa South, Tagaytay City Cavite has a very
cool and soothing environment due to cold weather and prominent location of trees.

Neighborhood Criminality: ( ) High ( /) Low ( ) Minimal

Explain: The Petitioner`s neighborhood has low crime rate for the past years

Community Acceptance: ( ) Poor ( ) Fair ( ) Satisfactory

( /) Very
Satisfactory

Specify: The Petitioner accepted relations to the community and its culture and traditions.

Availability of Resources for Rehabilitation:

( ) Poor ( ) Fair ( /) Satisfactory ( ) Very Satisfactory

Specify: The Petitioner`s nearby rehabilitation centers has a good performance when it comes
to rehabilitation of patients.

Peer Group Relationship: ( / ) Desirable ( ) Undesirable with Potential for

Improvement
( ) Undesirable with no Potential for
Improvement
Specify: The peer group relationship of the Petitioner is desirable due to good communication
PPA FORM 1

skills of the Petitioner.

PPA FORM 2

CERTIFICATION

I, KELLY BAGSIK SAMSUNG, hereby declare that the information and facts given

by me are true and correct to the best of my knowledge and I am aware of the intent and

consequence thereof.

Signed on the 22nd day of , 2023 at Tagaytay City , Philippines.

_______________________
Kelly Samsung (Petitioner)

ATTESTED:

I.O Dexter G. Macapunpon

Investigating Officer
JUNE 21, 2023
PPA FORM 2

REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF JUSTICE
PAROLE AND PROBATION ADMINISTRATION
CAVITE
TAGAYTAY CITY

WAIVER

I, the Petitioner, hereby authorize DEXTER G. MACAPUNPON of

Tagaytay City, Cavite, to secure and make use of the following information and/or reports
for purpose of evaluating my application for probation.

1. Record of previous arrest, arresting agency, date and place of arrest disposition.
2. School records.

3.. Medical records, including dates of all records of any physician, clinic or hospital where I
have sought consultation or received treatment.
4. Job records and information.

5. Others (Specify)

Signature

WITNESSES:

____________ _____________
Tatay Samsung Nanay Samsung

SUBSCRIBED AND SWORN TO before me this 23rd day of JUNE, 2023 at Tagaytay
City, Philippines.

CPPO Jerico Taaca

PPA FORM 3

PSIR RE: Investigation Docket No. PI2023123

Criminal Case Number 2023-1234

Republic of the Philippines

Department of Justice
PAROLE AND PROBATION ADMINISTRATION
_

POST-SENTENCE INVESTIGATION REPORT

I. IDENTIFYING DATA

PETITIONER: SAMSUNG KELLY BAGSIK

(Last Name) (First Name) (Middle Name)
True Name: KELLY B. SAMSUNG Source of Info:
Alias(es): “KEL” Height (meters): 1.69m Weight (kilos) 64kg
Age: 38 Sex: Female Citizenship: Filipino Religion:Roman Catholic
Identifying Marks/Unusual Features:
Present Address: Guinhawa South Tagaytay City, Cavite
Permanent Address: Guinhawa South Tagaytay City Cavite

II. PETITIONER’S CRIMINAL HISTORY

A. PRESENT OFFENSE
Charged with Adultery Date: JUNE 13, 2023 .
Convicted of Adultery
Date: JUNE 20 , 2023
.ddd
Sentence Three years and six months and one day of Prison Correctional
Judge Court MTC Tagaytay City
Hon. Peppa Malkova Address Indang, Cavite_
Defense Counsel Atty. Ace Alleje Address Tagaytay, City
Offended Party Clyde Samsung
Custody Status: ( ) On Bail (/) On Detention ( ) Period of Detention 1 year and 1 day
( ) ROR – Custodian
Address:
Manner of Commission (Narrative)
Age at time of commission–Extent of Participation:( /)Principal ( )Accomplice ( ) Accessory

I. Offenders Statement
I, Kelly B. Samsung wife of Clyde R. Samsung states that I am did not have any sexual
intercourse with Abraham Dela Cruz, on June 3, 2023. The lights in the bedrooms of the
house unexpectedly stopped functioning. Since my husband Clyde R. Samsung is not at
the house at that moment, I called Abraham Dela Cruz, a repairman that lives in the
neighborhood. Around 9:00 PM my husband Clyde R. Samsung came home drunk and
started confronting me of alleged cheating of mine, the confrontation started to worsen
when Abraham Dela Cruz started to stop the commotion between I and Mr. Samsung.
The commotion ended up with myself being filed with a case of Adultery which is
apparently not true because I did not commit any cheating on Mr. Samsung. But
somehow the Municipal Trial Court in Tagaytay City, Cavite ruled that I am guilty for
the case of adultery because I cannot present an evidence to prove my stand that Mr.
Samsung were drunk and falsely accusing me of cheating with Abraham Dela Cruz.
PPA FORM 3

II. Victim’s Statement

I, Clyde R. Samsung, the husband of Mrs. Kelly B. Samsung, is having suspicions of
cheating of Mrs. Kelly B. Samsung, On June 3, 2023 in Guinhawa South Tagaytay City,
Cavite around 9:00PM, I, arrived at home from my work as a welder in a construction
site in Tagaytay City, Cavite. From the moment that I entered our house, I heard
indiscreet noises from the upper bedroom in our house, With me being unknowing what
are going on inside the room I sneaked my way into the hallway and went into the front
of the bedroom door and noticed that it was locked, as I kicked the door open I saw
inside the room my wife Kelly B. Samsung and Abraham Dela Cruz Having sexual
intercourse, after seeing the act of my wife and Mr. Dela Cruz I confronted them and
called the authorities and filed an adultery case against my wife. At the time of the trial
her alibi that I was drunk at the moment I confronted her was questioned since I
presented an evidence supplementing my claim that I came from my workplace with a
time stamp of my exit from the construction site that I am working on, with her not
being able to supplement evidence for her questioned statements she had been found
guilty for the act of adultery. I also executed a breathalyzer test and drug test to prove
that I am not drunk at that moment.

REMARKS/ADDITIONAL INFORMATION

CONFIDENTIAL
PPA FORM 3

B. PRIOR RECORDS

Agen CC No./Date Offense Disposition/Date

cy
NBI N/A N/A N/A
RTC N/A N/A N/A
MTC N/A N/A
PNP N/A N/A N/A
Prosecutor N/A N/A N/A
Barangay N/A N/A N/A
CMRD N/A N/A N/A

C. OTHER DEROGATORY INFORMATION

Source/Position Particulars

III. PERSONAL AND SOCIAL HISTORY

A. PETITIONER’S BIRTH DATA
Date of Birth: June 12, 1985 Place of Birth: Tagaytay, City
Birth Order: 1st

B. FAMILY BACKGROUND
1. PARENTS:
Father: Samsung Tatay Age: 66 Occupation: Engineer
Last Name First Middle

Mother: Samsung Nanay Age: 63 Occupation: House Wife

Last Name First Middle

Status of Marriage: (/ ) Married ( ) Annulled ( ) Separated: Legal Estranged

( ) Common-Law/Live-in ( ) Others
2. SOCIO-ECONOMIC BACKGROUND
Family Relationship Major Family Problems Family Reputation in the
Communit
y ()
Very Satisfactory (/) No Apparent Problem (/) Very Satisfactory
(/) Satisfactory ( ) Economic ( ) Satisfactory
( ) Fair ( ) Mental/Physical Illness ( ) Fair
( ) Poor ( ) Marital Problem ()
Poor ( ) One-Parent-Family
( ) Parent-Child
Conflict ( ) Sibling
Conflict
( ) Others

Family Economic Status Physical Home Conditions Stability of

Residence ( ) More than Adequate (/) Very Satisfactory ( ) Stable
(/) Adequate ( ) Satisfactory (/) Occasional Change
( ) Inadequate ( ) Fair ( ) Frequent Change
( ) Below Poverty Line ( ) Poor ( ) No Stability

REMARKS/ADDITIONAL INFORMATION
PPA FORM 3

CONFIDENTIAL
 PPA FORM 3

C. PETITIONER’S PRESENT SITUATION

Civil Status: ( ) Single (/) Married ( ) Widow/Widower ( ) With Common-Law/Live-in

Partner Status of Marriage: Annulled Separated Legal / Estranged Others
Remarks :

1. Domestic Partner/Spouse Samsung Clyde Ramos

Full Name Last/Maiden Name First Middle

Age 38 Sex: (/) Male ( ) Female Occupation Welder

Home Address: Tagaytay City, Cavite
Work Address: Tagaytay City, Cavite

2. Children: Total No. of Children N/A

Ag In/Out of Educational Attainment Legitimat Illegitimat

e School e e

Relationship with Children: Very Satisfactory Satisfactory

Fair Poor
REMARKS/ADDITIONAL INFORMATION:

3. Residence
Dwelling Stability of Residence Physical Home Conditions
(/) Owned: Yrs of Stay:__ (/) Stable (/) Very
Satisfactory
( ) Rented: Yrs of Stay:__ ( ) Occasional Change ( ) Satisfactory
( ) Informal Settler ( ) Frequently Change ( ) Fair
( ) Others ( ) No Stability ( ) Poor
4. Economic Condition
Family Economic Status Family Breadwinner Petitioner’s Role in the
Family
(/) More than Adequate ( ) Petitioner ( ) Income Contributor
( ) Adequate (/) Spouse ( ) Total
( ) Inadequate ( ) Petitioner and Spouse ( ) Partial
( ) Below Poverty Level ( ) Others ( ) Primary Care-
giver (/) Dependent
5. Major Problems in the Family
( ) No Apparent Problem ( ) Mental Illness ( ) Sibling conflict
( ) Economic ( ) Physical Illness ( ) Others
(/) Husband-Wife Conflict ( ) Parent-Child Conflict

REMARKS/ADDITIONAL INFORMATION

CONFIDENTIAL
 PPA FORM 3

D. EDUCATION

Educational Attainment: Degree holder in Bachelor of Science in Industrial Engineering.

Over-all Conduct in School: Very Satisfactory / Satisfactory
Fair Poor

REMARKS/ADDDITIONAL INFORMATION

E. JOB HISTORY
1. Petitioner’s Previous Occupation: NONE
2. Petitioner’s Present Occupation: Accountant
Employer and Work Address: Tagaytay City
3. Present Work Status: ( ) Self-employed ( /) Regular/Permanent ( ) Temporary
( ) Contractual ( ) Casual ( ) Intermittent ( ) Seasonal
4. Special Skills:

REMARKS/ADDDITIONAL INFORMATION

F. MEDICAL HISTORY

Past Medical History N/A

Present Illness N/A
Present Medication N/A
Drug/Alcohol Use: ( /) No ( ) Yes Extent of Use:

REMARKS/ADDDITIONAL INFORMATION
_

G. PETITIONER’S TRAITS/CHARACTERISTICS:
Positive:

The petitioner displays a good sense of commitment is reformation and shows commitment for the
betterment
Negative: N/A

Overall Impression of the Client

The client executed and obeyed the conditions while on probation. The client showed
commitments and perseverance in reformation.
PPA FORM 3

CONFIDENTIAL
 PPA FORM 3

H. PETITIONER’S BACKGROUND IN THE COMMUNITY AND COLLATERAL

INFORMATION

Collateral Source of Relationship to Collateral Information Gathered

Information Client
Barangay Captain Rudolf Papa - Friend - The Barangay Captain stated
that the petitioner is a very sweet
and kind neighbor in their area.

- Sassy Bark - Best Friend - Sassy Bark explained that the

petitioner is a very loving wife to
her husband.

IV. ANALYSIS AND EVALUATION

According to the statements given by the acquaintances of the offender it shows that Kelly B Samsung is
a friendly and sociable person in their neighborhood. Also, as part of evaluation of their statements we
can perceive that Kelly B. Samsung the offender in this case is a responsible and loving wife to his
husband Clyde R. Samsung, both of the statements given by the acquaintances of our applicant Kelly B
Samsung shows positive traits of the applicant and states how she performs as an individual in the
society. From these statements we can form an analyzation and evaluation that Kelly B. Samsung can
reform and be reintegrated in the community because of his social reputation as sociable, good friend, and
a loving wife to his husband.

V.PROJECTED THRUSTS OF REHABILITATION

The following will be the Projected Thrust of Rehabilitation for Kelly B. Samsung:
1. Reparation for the offended party.
2. Reconciliation of offender, offended party, and the community.
3. Reassurance that the offender will be re-integrated to society after the probation period.
4. The offender will join various physical and spiritual activities to aid the probation,

CONFIDENTIAL
 PPA FORM 3

RECOMMENDATION

WHEREFORE, in view of the foregoing, it is respectfully recommended to the

Honorable Court that the petition for probation of Kelly B. Samsung to
GRANTED for a period of 1 year and 1 days, to be counted from Probationer’s initial report
for supervision and subject to the following conditions:
5. Probationers shall report initially to the Chief Probation and Parole Officer at

within seventy-two (72) hours from the receipt of the Order granting probation.
6. He/She shall, thereafter, report to his/her supervising Probation and Parole
Officer Jerico B. Taaca, unless otherwise modified by the Chief Probation and
Parole Officer.
7. He/She shall reside at and shall not change his/her residence without prior
approval of the Chief Probation and Parole Officer, or Court, as the case may be.
8. He/She shall secure a written permit to travel outside the jurisdiction of the
Parole and Probation Office from the Chief Probation and Parole Officer, and
from the Court if such travel exceeds thirty (30) days.
9. He/She shall not commit any crime or any other offense.
10. He/She shall render community service and will participate in tree-planting
activities.
11. He/She shall allow the supervising Probation and Parole Officer or an authorized
Volunteer Probation Aide to visit his/her home and place of work.
12. He/She shall meet his/her family responsibilities.
13. He/She shall undergo medical, psychological or psychiatric examination and
treatment and enter and remain in a specified institution, when required for that
purpose.
14. He/She shall devote himself/herself to a specific employment and shall not
change said employment without prior notice to the supervising officer and/or
pursue a prescribed secular study or vocational training.
15. He/She shall refrain from associating with persons of questionable character.
16. He/She shall cooperate with his/her rehabilitation and not unduly restrictive of
his/her liberty incompatible with his/her freedom of conscience.

In the event that Petitioner fails to observe the preceding conditions and/or has
committed any material misrepresentation in his application for probation, his probation may
be revoked by the Court or the conditions thereof modified.
Tagaytay City , Philippines October 23,2022

SUBMITTED BY:

Jerico B. Taaca
Probation and Parole Officer
Date:

APPROVED BY:

Chief Probation and Parole

Office Date:

CONFIDENTIAL
 PPA FORM 3

Investigation Docket No.

PSIR RE:
Criminal Case Number

RECOMMENDATION

WHEREFORE, in view of the foregoing, it is respectfully recommended to the Honorable

Court that the petition for probation of Kelly B. Samsung
be DENIED pursuant to Paragraph a and b, Sec. 8 of PD 968 as amended which states that the probation shall
be denied if:
“xxx (a) the offender is in need of correctional treatment that can be provided most
effectively by his commitment to an institution; or
xxx (b) there is an undue risk that during the period of probation the offender will commit another
crime; or
xxx ( c ) Probation will depreciate the seriousness of the offense committed.”
and/or
Section 9 of PD 968 as amended which states that the benefits of probation shall not be extended to
those:
(a) Sentenced to serve a maximum term of imprisonment of more than six (6) years;
(b) Convicted of any crime against national security or the public order;
(c) Who have previously been convicted by final judgment of an offense punished by
imprisonment of not less than one month and one day and/or a fine of not less than Two
Hundred Pesos; and
(d) Who have been once on probation under the provisions of this Decree; and
(e) Who are already serving sentence at the time the substantive provisions of this Decree
became applicable pursuant to Section 33 hereof.
and/or
subject to the provision of Sec. 4 of PD 968, as amended by RA 10707.
“SEC. 4. Grant of Probation. Subject to the provisions of this Decree, the trial court may, after it shall
have convicted and sentenced a defendant for probationable penalty and upon application by said defendant within
the period for perfecting an appeal, suspend the execution of the sentence and place the defendant on probation for
such period and upon such terms and conditions as it may deem best. No application for probation shall be
entertained or granted if the defendant has perfected the appeal from the judgment of conviction: Provided, That
when a judgment of conviction imposing a non-probationable penalty is appealed or reviewed, and such judgment
is modified through the imposition of a probationable penalty, the defendant shall be allowed to apply for
probation based on the modified decision before such decision becomes final. The application for probation based
on the modified decision shall be filed in the trial court where the judgment of conviction imposing a non-
probationable penalty was rendered, or in the trial court where such case has since been re-raffled. In a case
involving several defendants where some have taken further appeal, the other defendants may apply for probation
by submitting a written application and attaching thereto a certified true copy of the judgment of conviction.
“The trial court shall, upon receipt of the application filed, suspend the execution of the sentence imposed in the
judgment.
“This notwithstanding, the accused shall lose the benefit of probation should he seek a review of the modified
decision which already imposes a probationable penalty.
“Probation may be granted whether the sentence imposes a term of imprisonment or a fine only. The filing of
the application shall be deemed a waiver of the right to appeal.
An order granting or denying probation shall not be appeallable. ”

SUBMITTED BY:
Jerico P. Taaca

Probation and Parole Office

Date: June 26, 2023

APPROVED BY:

Chief Probation and Parole Officer

Date: June 26, 2023

CONFIDENTIAL
 PPA FORM 29

REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF JUSTICE
PAROLE AND PROBATION ADMINISTRATION
CAVITE
TAGAYTAY CITY

APPLICATION FOR PROBATION

Crim. Case No. 2023-1234

People of the Philippines

- versus -
Kelly B. Samsung ,
Accused

X X

The undersigned accused, Kelly B. Samsung a petitioner for probation under the
provisions of PD 968 as amended, hereby declares:

1. That Petitioner is 38 years of age, married and a resident of

Guinhawa South Tagaytay City, Cavite, Philippines ;

2. That Petitioner has been convicted of Violation of Article 133 of the Revised Penal
Code
and sentenced to serve a term of imprisonment of not more than six (6) years or to
pay a fine of not more than One Thousand Pesos (Ᵽ1,000.00) with subsidiary
imprisonment in case of insolvency;
3. That Petitioner has not begun to serve the term of imprisonment imposed nor paid the
fine imposed;
4. That the crime of which Petitioner has been convicted is not an offense against the
national security;
5. That Petitioner has not previously been convicted by final judgment of any offense
punished by imprisonment of not more than six (6) months and one (1) day or a fine
of not more than one thousand pesos (Ᵽ1000.00); and
6. That Petitioner has not been once on probation under the provisions of PD 968 as
amended.

TAGAYTAY CITY, CAVITE JUNE 26, 2023

(Place) (Date)

KELLY B. SAMSUNG
Print Name and Signature of Applicant

* In most cases, it is the client’s lawyer who prepares the petition for probation and submits the same to
the Court right after the promulgation of the sentence of conviction. This form, therefore, serves a
purpose only in cases where, for one reason or another, no such petition was prepared by the counsel or
where the assistance of the PPA Field Office is sought in this regard.
 PPA FORM 29
REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF JUSTICE
PAROLE AND PROBATION ADMINISTRATION
Region No.
TAGAYTAY CITY
CAVITE

FINAL REPORT
PEOPLE OF THE PHILIPPINES
Plaintiff CASE no. 20203-1234
VS. FOR: Adultery

KELLY B. SAMSUNG
Defendant

KELLY BAGSIK SAMSUNG Jerico P. Taaca VB2023-1234

TRUE NAME PROBATIONER SUPERVISION DOCKET NO.

______“KEL”_____ Hon. Peppa Malkova MTC Tagaytay

ALIAS JUDGE GRANTING PROBATION AND COURT

GUINHAWA SOUTH, TAGAYTAY CITY JUNE 27, 2023

ADDRESS/WHERABOUTS DATE OF PROBATION GRANTED

_38_ FEMALE MARRIED 1 Year and 1 day

AGE SEX MARITAL STATUS PROBATION PERIOD

A. ORIGINAL CONDITIONS OF PROBATION

B. OTHER CONDITIONS (If conditions have been modified)
C. PROGRAM OF SUPERVISION
D. RESPONSE OF PROBATIONER TO SUPERVISION PROGRAM
E. EVALUATION

Date Prepared:

Read and Approved By: Submitted by:

______________ _______________________________
Probation Officer Supervising Assistant Probation Officer
PPA FORM 11

INDEMNIFICATION PAYMENT PLAN (IPP)

CLIENT: KELLY BAGSIK SAMSUNG VICTIM/COMPLAINANT: CLYDE SAMSUNG

CRIMINAL CASE NO.: 2023-1234 AMOUNT: 30. 000 pesos
DOCKET NO. VB2023-123 MODE OF PAYMENT: Bank Transfer

SCHEME FORM OF
DA AMOUNT REMARK
TE OF PAYMEN S
PAYMEN T
T

- JUNE 28, Php 30, 000 - Bank Transfer - Cheque - Paid

2023

Clyde Samsung KELLY BAGSIK SAMSUNG

VICTIM/COMPLAINANT CLIENT

WITNESSES:
______________ _______________ _____________
TATAY SAMSUNG NANAY SAMSUNG P.O Jerico Taaca
PPA FORM 11

PAROLE AND PROBATION ADMINISTRATION

RESTITUTION/INDEMNIFICATION RECEIPT

Receipt No: 32123 Date: June 29, 2023

Received from KELLY B. SAMSUNGCC No.

Received from Kelly B. Samsung the amount of Thirty Thousand (Php 30, 000) Pesos as part of the
restitution/indemnification of Clyde Ramos for the month of June 18, 2023

Jerico P. Taaca
Probation Officer

Witnesses:
______________ _______________
TATAY SAMSUNG NANAY SAMSUNG
PPA FORM 11

PAYMENT CARD

RECEIPT MODE OF FORM OF

DATE AMOUNT REMARK
NUMBER PAYMEN PAYMEN S
T T
JUNE 29, PHP 30, 000 RN: 234 Bank Transfer Cheque PAID
2023

Original Copy: Client

Duplicate Copy: Victim
Triplicate Copy: Case
File
PPA FORM 16

PPA FORM 16

MY PERSONAL AND DEVELOPMENT PLAN

(PHASE 1: Start: 06-18-2023 End: 09-19-2023 ; PHASE II: Start: 09-19-2023 End: 12-20-2023; PHASE III: Start: 03-21-2024 End: 05-22-24; PHASE IV:Start: 06-24-2024 End: 07-18-2024)

Parole and Probation Office: Tagaytay City Hall of Justice Supervision Period: 1 year and 1 day

Docket Number: VB20213-1234 Supervision Level: ___ Minimum ___Medium

NEEDS/PROBLEMS
(Refer to MNPC Summary of ACTION/S TO BE TAKEN TIME FRAME STAT REMARKS
Priorities, US
BATH Plan, BATH Contract)
START E DONE NOT
N DONE
D
-Ignores and doesn’t interact with the -Seminar involving activities that administers individual in 06-18-2023 7-18-2024 DONE
community socialization
-Having difficulty in sharing her thoughts and -Provide a forum with other people where she could express 06-18-2023 07-18-2024 DONE
ideas her own thoughts and ideas freely

PROMISE TO DO MY BEST TO ACCOMPLISH MY PERSONAL DEVELOPMENT PLAN.

KELLY BAGSIK (06-18-23) _

Client/Date
_

WE PLEDGE TO ASSIST YOU TO FULFILL YOUR COMMITMENT.

_ _
VPA/DATE FAMILY
REPRESENTATIVE/GUARDIAN/DATE

_ _
Supervising Probation & Parole Officer/Date Chief Probation & Parole Officer/Date

Note: Use additional sheets if needed.

PPA FORM 25

Republic of the
Philippines Department of
Justice
PAROLE AND PROBATION ADMINISTRATION

Investigation Docket No.

Date of Report:

PRE-PAROLE/EXECUTIVE CLEMENCY
INVESTIGATION REPORT
I. IDENTIFYING DATA
Prisoner: PANDOY LAGHI JOPAY Prison No. 4567
(Last Name) (First Name) (Middle Name)

Alias(es): “PANDOY Identifying Marks:

Age:40 y.o. Sex: M Citizenship: FILIPINO Religion:Roman Catholic
Residence prior to NBP Imprisonment: BJMP TAGAYTAY
Where to reside after release: GUINHAWA SOUTH, TAGAYTAY CITY
With Whom: VILMA PANDOY Relationship: WIFE Occupation: VEGETABLE VENDOR

II. PRISONER’S CRIMINAL HISTORY

A. PRESENT CRIME AND IMPRISONMENT
Charge with: Violation of R.A 9659 Homicide Date: June 12, 2010
Convicted of: Homicide R.A 9659 Date: June 13, 2010
Sentence: 14 years six months and twenty-one day of Reclusion Temporal
Judge: Hon. Mary Juana Court: Municipal Trial Court Tagaytay City
Defense Counsel: Atty. Mama San Address:Tagaytay City
Offended Party: Juan Cruz Address: Tagaytay City
Extent of Participation: ( / ) Principal ( ) Accomplice ( ) Accessory
Co-Defendants: NONE
Names Disposition Custody Status

Appellate Court: Regional Trial Court Indang, CaviteG.R. No.: ***565

Expiration of Sentence with GCTA: MIN. : 14 years 6 months and 21 days
MAX. : 20 years to death
Pre-Conviction Detention: Inclusive Date : June 10, 2010
Total Period : 12 years

Time Served: 12 years

PPA FORM 25

Manner of Commission (Narrative):

On June 11, 2010 around 9:00 AM, Laghi Pandoy was selling vegetables in Guinhawa South,
Tagaytay City when a specific Juan Cruz approached Laghi Pandoy with a knife while shouting
and cursing him, Juan Cruz and Laghi Pandoy had an argument about money and forcing Laghi
Pandoy to pay for an amount of 10, 000 pesos. Laghi Pandoy refused to pay making Juan Cruz
wound Laghi Pandoy with a cut on his shoulder. Due to adrenaline, Pandoy ran, and because of
the speed of Juan Cruz, the latter charged Pandoy making them fall into the ground. , Laghi
Pandoy out-skilled Juan Cruz causing the the Pandoy to defend himself and hit Juan`s head with a
rock causing hemorrhage in the brain and killing Juan Cruz.

-C O N F I D E N T I A L -
PPA FORM 25

PPR Inv. Docket No.

Prison No. Page 2

B. PRISONER’S VERSION OF THE CASE:

The prisoner used self- defense at the day the crime is committed.

C. OFFENDED PARTY’S VERSION OF THE CASE:

The offended party charged Pandoy Laghi of Homicide for the crime happened out of rage.

D. OTHER PRIOR CRIMINAL RECORDS:

Agency CC No. /Date Offense Disposition/Date
NBI

RTC

MTC

PNP

Prosecutor

Barangay

CMRD

BPP’s
Previous
Action

E. OTHER DEROGATORY INFORMATION (include also from fellow inmates)

Source / Position Particulars
NONE

III. PERSONAL AND SOCIAL HISTORY

A. PRISONER’S BIRTH DATA:
Date of Birth: July 12, 1990 Place of Birth: Tagaytay City, Cavite

B. FAMILY BACKGROUND
1. PARENTS:
Father: Pandoy Tatay Age: 66
(Last Name) (First Name) (Middle Name)

Mother: Pandoy Nanay Age: 63

(Last Name) (First Name) (Middle Name)

Occupation: Father: Vendor Mother: Housewife

PPA FORM 25

Status of Marriage: (/) Married ( ) Separated ( ) Live-in/Common-Law

-C O N F I D E N T I A L -
PPA FORM 25

PPR Inv. Docket No.

Prison No. Page 3

2. SOCIO-ECONOMIC BACKGROUND:
Family Relationship Major Family Problems Family Reputation in the
Community
( ) Very Satisfactory ( ) No Apparent Problem ( ) Very
Satisfactory
( ) Satisfactory (/) Economic ( ) Satisfactory
( ) Fair ( ) Mental/Physical Illness (/) Fair
(/) Poor ( ) Marital Problem ( ) Poor
( ) One-Parent Family

( ) Parent-Child Conflict
( ) Sibling Conflict
( ) Others
Family Economic Status Physical Home Conditions Stability of
Residence ( ) More than Adequate ( ) Very Satisfactory
( ) Stable
( ) Adequate ( ) Satisfactory ( ) Occasional Change
(/) Inadequate ( ) Fair ( ) Frequent Change
( ) Below Poverty Level ( /) Poor (/) No Stability
COMMENTS: (Effects of the conditions on the prisoner’s behaviour)

PRISONER’S PRESENT SITUATION:

Civil Status: ( ) Single ( / ) Married ( ) Widow/Widower ( ) with common-law
spouse
( ) Separated (cause)

Spouse (Full Name) Pandoy Vilma Sasa Age: 20

(Last Name) (First Name) (Middle Name)

Home Address: Tagaytay City, Cavite

Occupation: Vendor
No. of Children: n/a

NAME AGE OCCUPATION

Relationship with Children: ( ) Very Satisfactory ( ) Satisfactory

( ) Fair ( ) Poor
PPA FORM 25

PPR Inv. Docket No.

Prison No. Page 4

3. RESIDENCE
Stability of Residence Physical Home Conditions
( ) Stable ( ) Very Satisfactory
( ) Occasional Change ( ) Satisfactory
( ) Frequent Change ( /) Fair
( /) No Stability ( ) Poor
4. ECONOMIC CONDITIONS:
Family Economic Status Family Breadwinner No. of Dependents
( ) More than Adequate ( ) Prisoner
( ) Adequate ( ) Spouse
(/ ) Inadequate ( /) Prisoner and Spouse
( ) Below Poverty Level ( ) Others
5. MAJOR PROBLEMS IN THE
FAMILY
( ) No Apparent Problem ( ) Mental Illness ( ) Sibling
Conflict
(/) Economic ( ) Physical Illness ( ) Others
( ) Husband-Wife Conflict ( ) Parent-Child Conflict
COMMENTS: (Effects of the above conditions on the prisoner’s behaviour)

C. EDUCATION
Highest Educational Attainment: College Graduate
Over-all Conduct in School: ( /) Very Satisfactory ( ) Satisfactory
( ) Fair ( ) Poor
Other Training/s Completed: TESDA MACHINING NCII
COMMENTS: The Prisoner shows excellent skills in mechanical and critical thinking

D. EMPLOYMENT HISTORY
Occupation Prior to Imprisonment: VENDOR

Employer and Work Address:

Status of Employment: ( ) Regular ( /) Irregular
Work while in Prison, if any: Farmer
Other Employable Skills: Machining Skills
COMMENTS: The Prisoner has multiple skills in livelihood.
PPA FORM 25

PPR Inv. Docket No.

Prison No. Page 5

E. HEALTH
State of Physical Health but Mental Health shall be determined by Physician/Psychologist of
the Bureau of Corrections: The Prisoner possesses good physical health and physique.

F. PRISONER’S CHARACTERISTICS
Positive: Fast learner and a good inmate. The Prisoner obeys all rules and regulation of the
Prison.

Negative: NONE

_
Comments:

G. PRISONER’S BACKGROUND IN THE COMMUNITY

H. COLLATERAL INFORMATION
Sources Significant Observations about the Prisoner
1. Family Members and Relatives : Pandoy Laghi is a very sweet and hard working. He
always provides for his family.

2. Peers : Laghi Pandoy is a true friend and he is very helpful

PPA FORM 25

PPR Inv. Docket No.

Prison No. Page 6

3. Neighbours: strong work ethic and dedication are truly admirable. He consistently goes
above and beyond expectations, willingly taking on additional responsibilities and
delivering outstanding results

4. School Authorities: has excellent communication skills and can effectively convey complex
ideas in a clear and concise manner

5. Employers/Business Associates/Co-Workers

6. Law Enforcers: an absolute good citizen. friendly and approachable, and he takes the time to
get to know everyone on our street. His warm demeanor creates a real sense of community
and connection."

7. Local Community Officials: is always ready to lend a helping hand with household projects.
Whether it's fixing a leaky faucet or offering tools and expertise, he's a reliable resource for
all of us.

8. Offended Party: We can really see the improvement of Laghi Pandoy. At first, I doubt that
he is a good person, but when we saw his improvements, he is really a good person.

9. Others
PPA FORM 25

PPR .
Prison No.

ANALYSIS AND EVALUATION

A. Positive Findings:
The Prisoner is a skilled and obeying inmate
inside the prison. He also attends various
physical and spiritual activities inside the
facility.

B. Negative Findings:
NONE

C. Conclusions:
The Prisoner does not contain any negative comments gathered.

D. Projected Thrusts of Rehabilitation

The prisoner shall still attend spiritual and physical events in his premises.

E. Recommendation
The Prisoner is applicable for clemency for he is qualified.

Prepared and Submitted by:

CPPO Jerico Taaca

Reviewed and Approved by: DATE:

NETTE/roehl c.
gaerlan A:\MISC.\
PECIR

-C O N F I D E N T I A L-
PPA FORM 25

PPR Inv. Docket No. ,

Prison No. Page 7

IV. ANALYSIS AND EVALUATION

A. Positive Findings
Upon the evaluation of Laghi Pandoy, it is evident that the offender is a sociable, and a
good person because upon meeting the offender he is very regretful of the crime he did
and accepts the consequences of his action. Also, upon conducting test to the offender,
he showed positive traits and passed the test to see if she is eligible for probation. His
social reputation of being a sociable, friendly, and a loving husband are one of the basis
of the positive findings determined, because it is already stated by his acquaintances.

B. Negative Findings
No negative findings has been found since the start of the background check of the
patient.
C. Conclusions
Upon analyzing the evaluations upon the offender, the offender is a good candidate for
Clemency. The positive findings discovered upon the subject are the basis of the decision
of her being granted with probation. His mistake could be corrected with the help of the
community in order to be able to reform herself and to avoid to conduct the previous
mistake that she had done.

D. Projected Thrusts of Rehabilitation

1. The offender will undergo spiritual and physical activities, and will report every 3 months
about his progress.
2. The offender will have a monthly visit by an assigned officer to check on the progress of the
offender`s family,
3. The offender will be given a job that is aligned in his capabilities.

E. Reccomendation

The offender should report more often about his progress in the community for he is left behind due
to his long sentence and it can cause culture shock and adjustments to the offender`s life as a free
person.

Prepared and Submitted by:

Signature Over Printed Name

Position/Designation

Date
Reviewed and Approved by:

Signature over Printed Name

Position